{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:03:40Z","timestamp":1791360220570,"version":"4.3.1"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Cyclic Mastalgia (CM) is the most common breast complaint among reproductive-aged women and can affect their quality of life. The exact etiology is not completely understood, but several factors are suggested to be effective. This study aimed to assess the relationship of some possible related factors with CM.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This cross-sectional study was conducted on 335 female students with severe cyclic Mastalgia. They were selected by multi-stage sampling method from dormitories of Shahid Beheshti University of Medical Sciences in Tehran-Iran. Data was collected using an online questionnaire including the Beck\u2019s Depression Inventory, the Spielberger Anxiety Inventory, the Fisher Body-Image Questionnaire, the Cardiff Breast Pain Chart (NDBP), and a socio-demographic questionnaire. The data were analyzed by SPSS 29 and using Spearman, Mann-Whitney, Kruskal-Wallis, and multiple linear regression tests.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The average age of the participants was 25.61\u2009\u00b1\u20095.92 years with a Cardiff score of 31.76\u2009\u00b1\u20094.33 (mean\u2009\u00b1\u2009SD). The mean scores for body image, anxiety, and depression were 159.33 (\u00b137.62), 43.35 (\u00b110.32), and 10.80 (\u00b19.79), respectively. Beck\u2019s depression score had a significant positive correlation with the severity of CM (P\u2009=\u20090.035). A significant positive correlation was also found between smoking and the severity of CM (P\u2009=\u20090.035, <jats:italic><jats:italic>r<\/jats:italic><\/jats:italic>\u2009=\u20090.115). There were significant positive correlations between the severity of CM with the duration of the menstrual cycle (P\u2009&lt;\u20090.001) and menstruation (P\u2009=\u20090.001). There were no significant relationships between the severity of CM with other variables. The multiple linear regression test demonstrated that depression (P\u2009=\u20090.014) and duration of the menstrual cycle (P\u2009=\u20090.001) are predictors of severity of CM.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Depression and duration of menstrual cycle are potential predictors of the severity of CM. Promotion of Women\u2019s menstrual and mental health as well as prevention of high-risk habits such as smoking should be considered for the severity of CM and improving the quality of life.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0330468","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T17:24:40Z","timestamp":1760462680000},"page":"e0330468","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["What are the underlying factors for the severity of cyclic mastalgia?"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4232-6020","authenticated-orcid":true,"given":"Soheila","family":"Nazarpour","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2843-3150","authenticated-orcid":true,"given":"Masoumeh","family":"Simbar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Kiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neda","family":"Khalaji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mobina","family":"Khorrami Khargh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"issue":"1","key":"pone.0330468.ref001","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1080\/00913847.2017.1252702","article-title":"The effects of exercise on mastalgia","volume":"45","author":"A Gen\u00e7","year":"2017","journal-title":"Phys Sportsmed"},{"key":"pone.0330468.ref002","volume-title":"Mastalgia. StatPearls [Internet]","author":"MT Tahir","year":"2022"},{"issue":"1","key":"pone.0330468.ref003","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4314\/ecajs.v23i1.9","article-title":"Mastalgia: A narrative literature review of current understanding and management","volume":"23","author":"SA Salati","year":"2018","journal-title":"East Cent Afr J Surg"},{"key":"pone.0330468.ref004","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1080\/07399332.2021.1887194","article-title":"Noncyclical and cyclical mastalgia in Turkish women: Prevalence, risk factors, health-care seeking and quality of life","volume":"43","author":"H Bolat","year":"2022","journal-title":"Health Care Women Int"},{"issue":"6","key":"pone.0330468.ref005","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1016\/j.ajog.2004.06.100","article-title":"European randomized, multicenter study of goserelin (Zoladex) in the management of mastalgia","volume":"191","author":"RE Mansel","year":"2004","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"pone.0330468.ref006","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1071\/HC18026","article-title":"Clinical management of idiopathic mastalgia: a systematic review","volume":"10","author":"SP Hafiz","year":"2018","journal-title":"J Prim Health Care"},{"issue":"3","key":"pone.0330468.ref007","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.apjtb.2015.12.008","article-title":"Cyclical mastalgia: Prevalence and associated determinants in Hamadan City, Iran","volume":"6","author":"F Shobeiri","year":"2016","journal-title":"Asian Pac J Trop Biomed"},{"issue":"2","key":"pone.0330468.ref008","first-page":"64","article-title":"Prevalence, severity and factors related to mastalgia among women referring to health centers affiliated with Shiraz university of medical sciences","volume":"4","author":"F Vaziri","year":"2016","journal-title":"J Health Sci Surveill Syst"},{"issue":"6","key":"pone.0330468.ref009","first-page":"566","article-title":"Cyclic Mastalgia in Iranian Women: A Review","volume":"24","author":"F Ghodsi","year":"2020","journal-title":"J Inflamm Dis"},{"key":"pone.0330468.ref010","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.ejogrb.2017.10.018","article-title":"Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments","volume":"219","author":"J-W Groen","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"pone.0330468.ref011","volume-title":"Mastodynia. StatPearls","author":"S Grullon","year":"2022"},{"key":"pone.0330468.ref012","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.amsu.2020.02.012","article-title":"Evaluation of mastalgia in patients presented to the breast clinic in Duhok city, Iraq: Cross sectional study","volume":"52","author":"AA Mohammed","year":"2020","journal-title":"Ann Med Surg (Lond)"},{"issue":"4","key":"pone.0330468.ref013","first-page":"343","article-title":"Common breast problems","volume":"86","author":"B Salzman","year":"2012","journal-title":"Am Fam Physician"},{"key":"pone.0330468.ref014","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.3889\/oamjms.2021.7538","article-title":"Body Mass Index and Other Factors Related to Mastalgia: A Cross Sectional Study","volume":"9","author":"R Sabry","year":"2021","journal-title":"Open Access Maced J Med Sci"},{"issue":"5","key":"pone.0330468.ref015","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/tbj.12305","article-title":"The prevalence, severity, and impact of breast pain in the general population","volume":"20","author":"J Scurr","year":"2014","journal-title":"Breast J"},{"issue":"1","key":"pone.0330468.ref016","article-title":"Relationship Between Mastalgia And Anxiety-Depression: An Observational Study","volume":"13","author":"MK Katar","year":"2021","journal-title":"Cureus"},{"issue":"3","key":"pone.0330468.ref017","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s12262-013-0813-8","article-title":"A systematic review of current understanding and management of mastalgia","volume":"76","author":"K Kataria","year":"2014","journal-title":"Indian J Surg"},{"issue":"2","key":"pone.0330468.ref018","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s12262-015-1325-5","article-title":"Effects of Mastalgia in Young Women on Quality of Life, Depression, and Anxiety Levels","volume":"78","author":"BH Kanat","year":"2016","journal-title":"Indian J Surg"},{"issue":"3","key":"pone.0330468.ref019","first-page":"100","article-title":"Mastalgia and associated factors: a cross-sectional study","volume":"29","author":"D Ko\u00e7o\u011flu","year":"2017","journal-title":"Agri"},{"issue":"2","key":"pone.0330468.ref020","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.37506\/ijfmt.v14i2.3222","article-title":"Risk Factors Related To Mastalgia","volume":"14","author":"SK Ali","year":"2020","journal-title":"Ind J Foren Med Toxicol"},{"issue":"1","key":"pone.0330468.ref021","doi-asserted-by":"crossref","first-page":"2620","DOI":"10.1038\/s41598-021-82099-2","article-title":"Effects of sagging breasts and other risk factors associated with mastalgia: a case-control study","volume":"11","author":"B \u00c7om\u00e7al\u0131","year":"2021","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0330468.ref022","doi-asserted-by":"crossref","DOI":"10.5812\/semj.88702","article-title":"Relationship Between Physical Activity and Cyclic Mastalgia in Iranian Women","volume":"21","author":"M Mirghafourvand","year":"2020","journal-title":"Shiraz E-Med J"},{"issue":"3","key":"pone.0330468.ref023","first-page":"156","article-title":"The Role of Nutrition in Women with Benign Cyclic Mastalgia: A Case-Control Study","volume":"14","author":"C \u0130diz","year":"2018","journal-title":"Eur J Breast Health"},{"issue":"3","key":"pone.0330468.ref024","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1159\/000444359","article-title":"Factors Effecting Mastalgia","volume":"11","author":"T Eren","year":"2016","journal-title":"Breast Care (Basel)"},{"issue":"2","key":"pone.0330468.ref025","doi-asserted-by":"crossref","first-page":"601","DOI":"10.4103\/jfmpc.jfmpc_1688_20","article-title":"An alternative yogic approach for cyclical mastalgia-A narrative review","volume":"10","author":"G Jaiswal","year":"2021","journal-title":"J Family Med Prim Care"},{"issue":"179","key":"pone.0330468.ref026","first-page":"1","article-title":"Relationship between depression and anxiety with the severity and length of cyclic mastalgia in women","volume":"18","author":"M Mirghafourvand","year":"2016","journal-title":"Iran J Obstet Gynecol Infertility"},{"issue":"2","key":"pone.0330468.ref027","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5152\/tjbh.2015.2363","article-title":"Relation between Mastalgia and Anxiety in a Region with High Frequency of Posttraumatic Stress Disorder","volume":"11","author":"EM Y\u0131lmaz","year":"2015","journal-title":"J Breast Health"},{"key":"pone.0330468.ref028","first-page":"111","article-title":"Prevalence of Cyclic Mastalgia and It\u2019s Relation With Age, Marriage and Employment Outside the House","volume":"9","author":"S Sharemi","year":"2000","journal-title":"J Guilan Univ Med Sci"},{"issue":"1","key":"pone.0330468.ref029","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1186\/s12889-023-17173-7","article-title":"Assessment of prevalence and factors affecting Mastalgia among early reproductive-aged women in Bangladesh: a cross-sectional survey","volume":"23","author":"AB Siddique","year":"2023","journal-title":"BMC Public Health"},{"key":"pone.0330468.ref030","unstructured":"Tariq M, Khan Y, Malik JN, Zafar Z, Tariq A. Is Education A Factor Influencing Benign Cyclic Mastalgia. Resident Journal of Rawalpindi Medical University. 2021;2(1). Available from: http:\/\/supp.journalrmc.com\/index.php\/residentJournal\/article\/view\/124"},{"issue":"1","key":"pone.0330468.ref031","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/j.1075-122X.2005.21492.x","article-title":"A randomized multicenter study of gamolenic acid (Efamast) with and without antioxidant vitamins and minerals in the management of mastalgia","volume":"11","author":"Efamast Study Group","year":"2005","journal-title":"Breast J"},{"key":"pone.0330468.ref032","unstructured":"Fathizadeh N, Takfallah L, Ehsanpour S, Namnabati M, Askari S. Effects of evening primrose oil and vitamin E on the severity of periodical breast pain. Iran J Nurs Midwifery Res. 2009;13(3). Available from: http:\/\/ijnmr.mui.ac.ir\/index.php\/ijnmr\/article\/view\/59"},{"issue":"4","key":"pone.0330468.ref033","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jpsychores.2009.04.003","article-title":"Sensitivity and specificity of the Beck Depression Inventory in cardiologic inpatients: how useful is the conventional cut-off score?","volume":"67","author":"T Forkmann","year":"2009","journal-title":"J Psychosom Res"},{"issue":"3","key":"pone.0330468.ref034","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1002\/gps.1664","article-title":"Usefulness of Beck Depression Inventory (BDI) in the Korean elderly population","volume":"22","author":"SA Jo","year":"2007","journal-title":"Int J Geriatr Psychiatry"},{"issue":"2","key":"pone.0330468.ref035","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1037\/0278-6133.20.2.112","article-title":"Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients","volume":"20","author":"RC Arnau","year":"2001","journal-title":"Health Psychol"},{"issue":"1","key":"pone.0330468.ref036","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/0272-7358(88)90050-5","article-title":"Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation","volume":"8","author":"AT Beck","year":"1988","journal-title":"Clini Psychol Rev"},{"issue":"6","key":"pone.0330468.ref037","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1002\/1097-4679(198811)44:6<853::AID-JCLP2270440604>3.0.CO;2-7","article-title":"Reliability and validity of the short form beck depression inventory with older adults","volume":"44","author":"F Scogin","year":"1988","journal-title":"J Clin Psychol"},{"key":"pone.0330468.ref038","volume-title":"Manual for the State-Trait Anxiety Inventory STAI (form Y) (\u201cself-evaluation questionnaire\u201d)","author":"CD Spielberger","year":"1983"},{"issue":"1","key":"pone.0330468.ref039","doi-asserted-by":"crossref","first-page":"315","DOI":"10.2466\/pr0.2002.90.1.315","article-title":"Psychometric properties of the statistics anxiety rating scale","volume":"90","author":"M Balo\u011flu","year":"2002","journal-title":"Psychol Rep"},{"key":"pone.0330468.ref040","volume-title":"State-Trait Anxiety Inventory: Bibliography","author":"C Spielberger","year":"1989","edition":"2"},{"issue":"3","key":"pone.0330468.ref041","first-page":"249","article-title":"The effect of aromatherapy with orange essential oils on anxiety in patients undergoing hemodialysis","volume":"19","author":"M Kanani","year":"2012","journal-title":"J Sabzevar Univ Med Sci"},{"key":"pone.0330468.ref042","article-title":"The guideline for state and trait anexiety test of Spielberger and the instruction for its explanation based on normality test research in Mashahad. Master\u2019s Thesis.[Tehran]:","author":"B Mahram","year":"1993"},{"key":"pone.0330468.ref043","volume-title":"Body Experience in Fantasy and Behavior","author":"S Fisher","year":"1970"},{"key":"pone.0330468.ref044","volume-title":"Fisher body image test","year":"2010","edition":"1"},{"issue":"13","key":"pone.0330468.ref045","first-page":"65","article-title":"Relationship between emotion regulation, mental stresses and body image with eating disorders of women","volume":"4","author":"P Asgari","year":"2009","journal-title":"J Thought Behav Clin Psychol"},{"issue":"56","key":"pone.0330468.ref046","first-page":"344","article-title":"Correlation between body image and coping styles with severity of primary dysmenorrhea","volume":"14","author":"S Nazarpour","year":"2012","journal-title":"J Fund Mental Health"},{"issue":"1","key":"pone.0330468.ref047","doi-asserted-by":"crossref","DOI":"10.2174\/0118741045371715250404073206","article-title":"Mastalgia in Fibrocystic Changes; From the Diagnosis Bench to Innovative Therapy: A Narrative Review","volume":"19","author":"W Nori","year":"2025","journal-title":"Open Med Chem J"},{"issue":"9","key":"pone.0330468.ref048","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.tins.2008.06.006","article-title":"The HPA axis in major depression: classical theories and new developments","volume":"31","author":"CM Pariante","year":"2008","journal-title":"Trends Neurosci"},{"issue":"4","key":"pone.0330468.ref049","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1503\/jpn.150205","article-title":"Why is depression more prevalent in women?","volume":"40","author":"PR Albert","year":"2015","journal-title":"J Psychiatry Neurosci"},{"issue":"22","key":"pone.0330468.ref050","doi-asserted-by":"crossref","first-page":"5729","DOI":"10.3390\/ijms20225729","article-title":"An Association of Serotonin with Pain Disorders and Its Modulation by Estrogens","volume":"20","author":"S Paredes","year":"2019","journal-title":"Int J Mol Sci"},{"issue":"4","key":"pone.0330468.ref051","doi-asserted-by":"crossref","first-page":"3257","DOI":"10.3390\/ijerph20043257","article-title":"The Involvement of Prolactin in Stress-Related Disorders","volume":"20","author":"A Faron-G\u00f3recka","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0330468.ref052","first-page":"1719","article-title":"Prolactin in cyclic mastalgia","volume":"21","author":"RA Yonis","year":"2021","journal-title":"Biochem Cell Arch"},{"issue":"2","key":"pone.0330468.ref053","doi-asserted-by":"crossref","first-page":"162","DOI":"10.5455\/ijmsph.2016.18122015291","article-title":"Integrated yoga therapy for mastalgia","volume":"5","author":"R Sukanya","year":"2016","journal-title":"Int J Med Sci Public Health"},{"issue":"2","key":"pone.0330468.ref054","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1093\/jbi\/wbz082","article-title":"A Review of Breast Pain: Causes, Imaging Recommendations, and Treatment","volume":"2","author":"R Sivarajah","year":"2020","journal-title":"J Breast Imaging"},{"issue":"3","key":"pone.0330468.ref055","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.ajog.2020.03.002","article-title":"Association between dysmenorrhea and chronic pain: a systematic review and meta-analysis of population-based studies","volume":"223","author":"R Li","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"pone.0330468.ref056","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.bja.2023.12.034","article-title":"Chronic nicotine exposure elicits pain hypersensitivity through activation of dopaminergic projections to anterior cingulate cortex","volume":"132","author":"D Chen","year":"2024","journal-title":"Br J Anaesth"},{"key":"pone.0330468.ref057","article-title":"Mastalgia: Characteristics and Associated Factors in Thai Women","volume":"98","author":"D Songtish","year":"2015","journal-title":"J Med Assoc Thai"},{"issue":"4","key":"pone.0330468.ref058","doi-asserted-by":"crossref","first-page":"285","DOI":"10.35787\/jimdc.v9i4.561","article-title":"Mastalgia: Risk Factors and Treatment Strategies Used at Two Breast Clinics in Pakistan","volume":"9","author":"R Bano","year":"2020","journal-title":"J Islamabad Med Dental Coll"},{"issue":"3","key":"pone.0330468.ref059","first-page":"108","article-title":"Prevalence of mastalgia in young Indian females","volume":"2","author":"S Raghunath","year":"2015","journal-title":"J Health Res Rev"},{"issue":"4","key":"pone.0330468.ref060","doi-asserted-by":"crossref","first-page":"485","DOI":"10.14744\/SEMB.2023.75002","article-title":"Identification of Risk Factors for Mastalgia and Its Relationship with Benign or Malignant Breast Diseases","volume":"57","author":"B Yigit","year":"2023","journal-title":"Sisli Etfal Hastan Tip Bul"},{"issue":"4","key":"pone.0330468.ref061","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1136\/bjsports-2013-092175","article-title":"The experience of breast pain (mastalgia) in female runners of the 2012 London Marathon and its effect on exercise behaviour","volume":"48","author":"N Brown","year":"2014","journal-title":"Br J Sports Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330468","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T17:25:06Z","timestamp":1760462706000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330468"}},"subtitle":[],"editor":[{"given":"Erfan","family":"Ghadirzadeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":61,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0330468","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]}}}